Expert Answer: How can I manage triggers such as stress & environmental changes?

As for stress being a trigger, there’s still some controversy, but I hate to see anyone accept that stress is a trigger without at least trying to see if they encounter triggers during stressful times that they either don’t encounter at other times or they’re only triggers when the body is stressed.

The International Headache Society has removed stress from their list of Migraine triggers and put it on their list of exacerbating factors- things that make us more susceptible to our triggers. I’d have sworn stress was a trigger for me until I kept a very detailed diary for a few months. I hope you’ll thoroughly investigate this as I think we do ourselves a real disservice by thinking stress is a trigger for us and not looking closely for other triggers during stressful times.

If by environmental changes, you mean weather changes/changes in barometric pressure, some Migraineurs have found that they can avoid at least some Migraines from this trigger by taking Diamox when they know a weather front is coming. This also applies to Migraines triggered by flying or changes in altitude.

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Stress is definitely a trigger for me.Not so much as stress at home but stress at work definitely plays a part in my migraines.If I could figure out how to lessen my stress at work then I think some of the headaches would decrease, maybe? Although my doctor would disagree.

Bonna and Janice, you might keep a very close Migraine diary during stressful times for a while to see if it’s stress itself that’s your trigger or things that you do or don’t do during stressful times. I’d have sworn that stress was a trigger for me until I did that. I discovered that it wasn’t stress. It was skipping meals, not sleeping well, not drinking enough water, and some other things that I do or don’t do during stressful times. Now that I know that, and can change those behaviors, I have far fewer Migraines during stressful times.

The doctors may be book smart but until they can actually feel what we feel they will never know the pain of a migraine. My neurologist’s PA whom I see told me he has never had a migraine so he couldn’t possibly know what it is like. At least he was honest but still I have the headaches, the pain and no relief yet. The only time I get relief is when he put me on prednisone for 10 days. I turned in to the bitch from hell, that’s what happens when I take steroids. Mood swings, bad attitude but the headaches did get better but my husband said he preferred sleeping in the garage.lol. I am currently on metoprolol, neurontin and nortriptylline and still have the headaches. So what do I do? Everyone tells me not to take otc’s for pain or the esgic I was on, so do I just suffer with this? That’s the impression I get from all the doctor’s. I don’t tell anyone anymore if I have the headache because I think people are just tired of listening to me. So when they ask me how I am my standard answer is “I’m fine, thank you”. Sorry, just a little on edge as I have the headache today and I have so much to do.

Stress is a trigger for me too, and you know they are now ‘declaring’ that stress is not a trigger, so I expect to stop getting migraines from stress – LOL! Don’t you love when doctors tell us what we are feeling or experiencing and they are so far from the truth?

I have migraines with pretty much every cause & trigger listed! Especially barometric changes, like a human barometer. Is Diamox something to take with or instead of Imitrex? Anyone on Diamox? I either have pain always left side above eyebrow, or the “vice grip” kind which is def more sinus or weather change related. thanks!

I find that drinking tons of water help…i also get thunderstorm/hot weather related migranes..but my body starts reading it sometimes days/hours before. My stomach get a bit nauseous, I get slightly constipated and then quite pale…tehn the headepain stars…if I dring water before a blown migraine is there and if I eat some alkalising greens I manage to avoid it.

I had headaches when I was going threw menapose, But also found out every time I colored my hare I had bad hwadachesI was allergic to the ppa ingretant and now they have gotten better but when I get them they are bad!

I FEEL STRESS CAN TRIGGER MIGRAINES.MY CAT BECAME SICK AFTER EVERYTHING WAS SETTLED GUESS WHAT! I HAVE A MIGRAINE.THINGS GET CRAZY @ WORK & HAD A BAD COUPLE OF DAYS @ WORK I GET A HEADACHE.NOW ALLERGIES! THAT’s ANOTHER ONE.

One of my biggest triggers used to be weather changes. Then one day I realized that I wasn’t getting migraines from weather changes and I didn’t know why. I’m glad that it doesn’t trigger them any more but, now I have other triggers and many more than I used to. The only environmental triggers that I have now are from very bright days, traffic/fuel fumes and other peoples second had smoke. This last one, second had smoke, is the worst. I only have to smell it one time and only for a second. I don’t think that designated smoking areas are far enough away from most public buildings. Even if it were, I can still smell it on the clothes of smokers. My worst trigger is the hardest to get away from.

I just started getting migraines in the past few months. I really am not sure exactly what is causing them. It really isn’t normal for me to have headaches either, let alone migraines. I talked to my doctor and he told me to just take excedrin migraine, sometimes it helps and sometimes it doesn’t. I hate the migraines.

Bonna Mullaly I hope it’s only 2 months to break the cycle because I have the weight problem too when I am on it.Then it flares up my RA and the joint pain increases and then I have a whole nother issue with the RA. Hopefully just 2 months if I can handle the issue. I agree, may everyone have a peaceful migraine free night!

Janice Worden Lamb Clemens I’ve been given dose packs of prednisone to ‘break the cycle’ and it’s worked. Are you on it long term then or just the 2 mos and then taper? I can’t have it long term from what they tell me, b/c I’m high risk for diabetes and I think maybe b/c of high blood pressure? Not sure. It also packs the weight on me – which depresses me and flares up the joint pain making it hard to get the little bit of exercise I force myself to get. Whoever invented migraines needs to be whipped!!! LOL – may everyone have a peaceful migraine free night and a good night’s sleep! 🙂

I also refuse to let my migraines dictate my life but the difficult part for me is the daily headache, which I still have. So my doctor put me back on prednisone. This time I am supposed to be on it daily for at least 2 months then taper down the dose to the lowest dose possible. I t has been the only thing that gets rid of the headache. I hadn’t had a bad migraine in about 3 weeks but the daily headache just wears me down. I am on blood pressure medication to control the headache as well as my blood pressure, I am on lyrica which I’m not sure is working but I am giving it a try. I have been on Topamax, and depakote with no relief from either as preventative. I take thyroid medication and have been on it for about 12 years, so that’s not a problem. The doctor’s think that all the headaches are coming from the arthritis in my neck. Maybe , but I am trying to do what they tell me to . Today was one of the worst and I took what I had to take to get through the day because I had to go to work. Haven’t had to go to the ER in many years and will never if I don’t have to, as I cannot tolerate the way I was treated when I did go. I am not seeking anything but relief from the migraines. I have kept a diary, I have watched for food triggers, Weather is not a factor. I am at the end of the rope and holding on. Stress from work is the biggest and I am now trying meditation to help with the stress. We shall see if it helps because I have to work and jobs are few and far between so changing is out of the question.

I refuse to let them dictate my life too. There are some days they do take over, but usually I can take my meds and after a bit, I might not be pain free but can do what I need to and at least some of what I want to. I can’t take topomax, I get really bad short term memory loss (to the point of not being able to find my way home) and if I remember correctly, tremors and numbness around my mouth. I forget the count of the number of preventatives I’ve tried. Right now, my blood pressure medicines are 2 of the ones that can help with migraines – don’t know if they help much but hate to think how bad they might be without them. Also I’m hypothyroid and only was diagnosed a year ago, so it is still an up and down process dosing my meds……I can tell when it is low – migraines are much worse then. Hoping that once we get thyroid regulated that will tame these monsters a bit! But, I know I rarely get rebound headache – when you’ve had a migraine or headache pretty much non stop for weeks and taken analgesics, and then you go 1 or 2 weeks with no migraines, I can’t buy the rebound idea, and I still say we are all different. Don’t want to damage my heart, so the triptans are out and I apologize to no one, and gratefully thank my doctor for making sure I do have the pain medicine I need to keep me functioning – and working! I have 2 different ones, I try one and if it gets worse or is relentless, then it is on to Stadol. Don’t need the Stadol much, and I think just knowing it is available if I do need it helps. I also have phenergran for nausea – which sometimes taking it by itself and going to bed will take the migraine away.

Well I think we all learn what things we must avoid if we don’t want to pay the price. I haven’t been to an ER for a migraine in years, although I was always well treated – I’ve just heard of others that weren’t. I’ve never had a tox screen ran, I’ve been checked for strokes, had CT scans – but after they medicated me to give me some relief. A good med professional can SEE it’s a migraine and there is no faking that look! But really the bright lights and noise while waiting I just can’t do it. I’ve toughed out many of them late at night, just will not put myself through that, I’m always even worse by the time I’m seen. I wish I could take topomax, have tried it, cannot take it. From what I hear – either it is a wonder drug or it doesn’t do a thing but give you side effects to deal with on top of migraine. I also cannot take any NSAIDS, so those are out for me. My body just is very picky about what meds it will tolerate. I’m allergic to many, many antibiotics, which when I need one, that’s always a challenge for the doctors too. I have a feeling that there are many causes of migraine and one just very well may be an auto immune disorder. I am thankful that I do have understanding doctors that make sure I have rescue meds, 2 different ones depending on the severity, to keep me from needing an ER – except for those rare ones – and like I said, I won’t go, hubby knows I’d have to be comatose to go. I will go to the doc during office hours, but no ER’s, just cannot take the drama, lights, noise. I can stop migraines from dictating my life to some degree, but they are part of my life and I know there will be times that I cannot do what I want, there are things I cannot eat, things I cannot do, so yes, they do dictate a large part of my life.

My type of migraine does not warrant me taking triptans or other meds either so for that I am taking Topamax (other seizure medications could also be an option for my complex migraines). When I started taking this medicine I noticed a significant decrease (though they are still there to some extent) in my overalll migraine symptoms–headache pain, auras, numbness, slurred speech, and inability to move. However, on occasions I may experience 1 or more of these symptoms on a much lesser scale. Maybe once a month, I will experience a full blown migraine with all the above symptoms, usually because I ate something I shouldn’t have, the weather is really bad, or I am super stressed. Only then will I take 2 alleve once time or if I have something to do, go to the er. If it is really bad, I will barely be able to walk and my husband will have to translate my jibberish speech, they run a toxic screen and don’t question my migraine. As much as it stinks, I have accepted my migraines are a disease I have to live with: I know my food triggers, as much as I love them, I avoid them. I don’t argue, even though I love it. I go to bed early even though I rather watch a movie. I hate migraines ,and I will not let them dictate my life.

I think they need to develop something that makes us ‘immune’ to rebound headache but I also think they need to be slower to call it rebound when in fact it could be one of those that just won’t stop. I hear what you are saying – and see – you know the difference btwn headache and migraine – we need doctors and other professionals to understand that after 283924789374894759 migraines and 23489289 headaches, we do understand which it is that we are having! Nobody should have to suffer through a migraine with nothing for relief and we shouldn’t be stuck with having to go to an ER with bright lights, loud noises only to wait for hours and then be treated like a drug seeker….and I haven’t been to the ER for a long time, and all of the above happened except they have never treated me as a drug seeker. There simply isn’t enough awareness about migraines. Considering how many of us have migraine, that just doesn’t make sense – reminds me of how men with chest pain will generally be taken far more seriously than a woman with chest pain…..modern day medical professionals, far too many of them still see us a drama queens wanting attention. No, doc – I get plenty of attention, and spending time in your office or an ER is not my idea of fun, I’d rather be doing all those fun things we had planned.

I agree but when your head hurts so much that you want to blow your brains out what do you do? I am working with my neurologist to find something to prevent the headaches but since we are still trying to find a compound that works in the meantime I have the daily headache, plus at least 1 migraine every other week., and I still have to function and go to work. any suggestions ? I totally understand the rebound headche(been there) but I don’t know how much more I cantake of this headache….

What would you suggest for people that cannot take triptans, DHE, etc., and the only thing they can take is pain relief? I also think the amount of pain relievers that cause a migraine varies greatly, and there is no one size fits all. I’ve gone from needing them daily for over a week, and then follow up with 2 weeks with no migraine, so I simply do not buy that theory. Migraines have to be treated, even for those of us who can’t take other migraine abortives.

Beware of taking excedrin or any type of pain-relief medication every time you have a migraine. Migraines are very susceptible to rebounding from overuse of medication used to end them. And by overuse I mean one dose (2 pills) more than 2 or 3 times a week, never more than one dose 10 tiimes a month. If you need more than that your doctor should be working with you to find another way to combat your migraines.

I have migraines almost every single day. It’s rare for me to have a day without one. I know all my food triggers and avoid them. I’ve tried tons of preventative meds but nothing helps. I’m currently on enderol. I take allergy meds and have been getting allergy shots for 2 years but that doesn’t really help either. I’ve tried acupuncture, exercise, chiropractor, massage, everything! I even paid out of pocket for “migraine surgery” – which was occipital nerve decompression, sinus surgery and removing nerves around eyes and temples. The weather is my main trigger, even the smallest weather change will trigger one. I even get a migraine when I travel from one microclimate to another. Botox helps a little but my insurance won’t pay for it so I can’t do it very often. It all just keeps getting worse and worse. It’s really ruining my life and I’m feeling totally helpless. Please help!

I take Topomax twice daily for my migraines. It is actually a seizure medication. I too was getting them almost daily and taking huge doses of triptans which failed leaving me to make trips to ER and urgent care for shots to control pain and vomiting. In 8 months I have had 1 urgent care trip and have used 13 immitrex tablets, a HUGE improvement. It has done wonders and I have a lot of triggers, bright lights, some foods, my menstrual cycle and loud noises all are triggers as is the weather so I get them at the drop of a hat!It has been my miracle drug!

Dina, I’m so sorry to hear. There is a migraine support group in Burlingame you can find under “Meetup” groups. Things can get better, they did for me. It takes a lot of trial and error, and patience. I know it seems like you’ve tried everything, but perhaps there will be something more that may make your life more manageable.

@jennifer boy I used to feel the same way, can’t wait for winter, until I got a really out of this worl migraine in january, that lasted for 6wks. that’s how I knew my migraine had changed, that and the fact that my head now felt like someone was bashing me in the head with a baseball bat, it was the sore to the touch headpain. something I had never felt before.My migraine used to be seasonal, now I don’t know what’s going on. I have had a headache ever since the migraine went away, and I don’t know what’s causing them. Hope to have some answers soon.

The migraines were no better for me in the winter. Actually it was more depressing in the winter which seemed to compound them even more. That with the changes in the weather fronts, lack of sleep, stress & hormonal changes it’s a year-round pain-ridden vicious cycle. Thank God for up to date info I get from Migraine.com. I had never heard of Diamox before & after seeing it posted today in the article about stress & weather changes “I” had to be the one to ask my Dr if I can try this since changes in the weather really effect me! Now he knew that before but how come HE, the paid professional so-called expert, know to suggest this medicine earlier-like a few years ago! If this works it could have saved me from some horrible pain. As it is this won’t be a cure-all, if it works that is. The old saying goes is true-patients need to research & be their own advocates & be an educated patient, not passive as that will get you nowhere fast. Thank you again Migraine.com for great info.

Too much pain meds can damaged your liver…….so this is the anwer to those terrible Migraines Pains and keeping it under control…….you can detoxified your body while staying away from Pain Meds……Great way to go.

I have had migraines since I was 8, and I’m now almost 50, so I know my body well. I am a stressed person in general. I definitely get the worst migraines when I have extreme stress. The headache will appear immediately following an awfully stressful situation.

Weather is my biggest trigger. I am better than the weather man. I am not even the one that discovered it. A dear friend of ours said did you notice when we get a storm that morning or the night before you get a migraine. Almost every time. I am going to the Dr today to see what we can do for preventive. I don’t think a pill taken when a storm is coming in is the best option because there are so many variables but we will see.

I tracked all kinds of things that I might do differently during stressful periods…
• When I ate. (messed up meal schedule)
• What, how much, and when I drank fluids. (dehydration)
• Not drinking too much caffeine.
• If my sleep got messed up.
• Crying

The other thing is to watch all of our “regular” Migraine triggers when stressed. It’s kind of like catching a cold. If you catch a cold during a stressful period, it’s not the stress that caused the cold. It’s the virus. Stress just made you more vulnerable to it. Same thing with Migraines and stress. Stress affects our bodies in ways that make us more vulnerable to our triggers.

Amrita gave to the link to our diary tool. To this day, during really stressful times, I take a piece of brightly colored paper, write “MIGRAINE TRIGGERS” on it, and put it on the bulletin board next to my desk. It helps me remember to take better care of myself during such times.

I’d have sworn stress was a trigger for me until I was challenged on it. I’m so glad now that someone did challenge it because I’ve learned what I do or don’t do during stressful times that really are triggers for me. That means so many fewer Migraines then.

Diamox (acetazolamide) is one of those multi-function drugs. It has some anticonvulsant properties and some diuretic properties. It’s often used to treat idiopathic intracranial hypertension / pseudotumor cerebri. It’s theorized that what makes flying, altitude, and barometric pressure changes trigger us is that they impact our cerebrospinal fluid pressure. Thus, using Diamox as a preventive. I know several people who use it as an “as needed” preventive, not taken daily, but when flying, traveling to higher altitudes, or when a weather front is coming through.

Now about these cluster headaches. Are you saying ONE cluster headache lasts five days? If so, it’s most likely not a cluster headache. Cluster headaches last 15 – 180 minutes and occur in groups/clusters, thus the name.

In a word, yes. I have both TTH and Migraine with and without aura. When I get a TTH, I know I have to knock it fast, or it will indeed trigger a Migraine. If that’s happening to you, it couldn’t hurt to talk with your doctor about what you should do for your TTH.

Hi Jane – There are a variety of triggers you may want to consider in addition to foods, including sleep (too much, too little), your eating schedule, smells, sounds, bright lights, etc. You can read more here: http://migraine.com/migraine-triggers/

I was wondering about the detailed diary…what type of details did you keep track of? I have kept a record of what I have eaten to see if there are any food triggers but I am curious about what else you tracked. Thanks for your thoughts.

After I did the same thing you did keeping sometimes minute by minute records, I discovered that anxiety was my trigger, not stress by and of itself. Stress without anxiety isn’t a problem.

I’ve spent a year working very hard at anxiety management and good emotion hygiene. I can’t say my efforts have had more than modest effects so far, but I believe with continued work I’ll learn how to head it off at the pass, if you’ll pardon the pun. XD

I need to look into Diamox. I’ve heard of it but don’t know a thing about it. If it might help through prevention, I’m there.

I will ask my neurologist in a couple of months about Diamox…..I’m intrigued only because I do get a lot of pressure headaches with weather changes. My irritation is with the cluster headaches that can last up to 5 days, with no known trigger.

I am wondering if stress can trigger a muscle tension headache which can turn into a migraine if left untreated. Inadvertently can stress not play a role in migraines? I think how we handle stress would play a part in whether it triggered a migraine.